Use of Acupuncture and Allied Reflex-Therapies in Ulcerative Conditions: a Bibliography from Medline Abstracts

(Oct 15th 1997)
Philip AM Rogers MRCVS,
1 Esker Lawns, Lucan, Dublin, Ireland 
e-mail: philrogers@tinet.ie

PubMed MEDLINE (http://www.ncbi.nlm.nih.gov/PubMed/medline.html) was searched on October 15th 1997 for papers which cited acupuncture or related reflex-therapies in ulcerative diseases. Medline yielded 117 Hits, of which 90 (77%) were in languages other than English (Russian 43; Chinese 28; Italian 10; German 4 and Czech, French, Hungarian, Spanish and Ukrainian 1 each).

Eighty-nine of the titles (many with abstracts) were useful in relation to gastro-duodenal and colonic and other (peripheral) ulceration. The data were reformatted, edited and sorted by author under three headings:

a. gastric, peptic, gastroduodenal and duodenal ulcers (62 hits)
b. ulcerative colitis ( 3 hits)
c. other forms of ulceration, peripheral ischaemia (24 hits)

The data indicate that acupuncture and allied reflex therapies merit serious consideration in the clinical management and/or therapy of these conditions.

A. GASTRIC, PEPTIC, GASTRODUODENAL AND DUODENAL ULCERS
(Note that if all inflammatory conditions of the gastrointestinal tract were added, many more hits would have resulted)

Andreev BV, Vasil'ev IuN, Ignatov IuD, Kachan AT, Bogdanov NN (1981) Effect of EAP on signs of emotional stress caused by pain. [In Russian]. Biull Eksp Biol Med 91(1):18-20. The experiments on male white rats have shown that EAP of the point analog GV14 abolished the consequences of pain-induced acute emotional stress. As compared with the control group exposed to stress, EAP had a stress-protective action comparable with that of diazepam in a dose of 2.5 mg/kg. EAP significantly reduced the number of gastric erosions and emotional reactivity, and reduced aggressiveness. The data obtained are discussed from the standpoint of EAP and diazepam action on the antinociceptive mechanisms of the brain.

Anon (1993) Clinical observations on the treatment of 98 cases of peptic ulcer by massage. Bei Y Dept of AP and Massage. JTCM Mar;13(1):50-51. Fujian Coll of TCM, Fuzhou.

Anon (1975) Treatment of acute perforation of peptic ulcer with combined TCM and Western medicine. Chin Med J (Engl) Jul;1(4):247-256.

Anon (1978) Further experience in treatment of acute perforation of peptic ulcer by combined TCM and western medicine. Chin Med J (Engl) Sep;4(5):379-382.

Asauliuk IK, Boichak MP, Golik LF (1996) The combined treatment of peptic ulcer with the differentiated use of nontraditional physiotherapeutic methods. [In Russian]. Lik Sprava Oct;10-12:119-122. Efficiency was studied of multimodality treatment of 586 patients with ulcer disease. Of these, 110 had gastric ulcer, 460 patients had duodenal ulcer, 16 were suffering from both gastric and duodenal ulcer. 275 patients (46.8%) had various concurrent chronic disorders involving cardiovascular system and alimentary canal. Three groups of patients were identified: those receiving magnetoresonance therapy apart from conventional antiulcer therapy (n=89), those undergoing laser therapy (n=170), those exposed to hyperbaric oxygenation (HBO), variable magnetic field (VMF) and AP by generally accepted techniques. Drug therapy promoted ulcer healing in 73% of control patients. Multimodality treatment involving MRT induced healing in 81% and incorporation of computer-aided laser therapy induced healing in 86-89%. HBO, VMF and AP induced healing in 92-94%.

Bragin EO, Emel'ianenko IV (1989) Effect of AP on the catecholamine content in the hypothalamus and brain stem of rats with an experimental stomach ulcer. [In Russian]. Biull Eksp Biol Med Feb;107(2):182-184. Significant increase of dopamine (DA) in hypothalamus and epinephrine (E) in the brain stem were revealed in the experiment on rats with experimental gastric ulcer (EGU). An AP session produces a prominent increase in DOPA and especially DA in hypothalamus of the rat with EGU. Under the same conditions A, DOPA and DA in the brain stem increased as compared to the control. It is assumed that AP produces a correcting effect on the reconstructive processes of catecholaminergic systems of the brain occurring in visceral pathology.

Bragin EO, Emel'ianenko IV, Popkova EV (1989) The ratio of the contents of beta-endorphin, adrenaline and noradrenaline in the hypothalamus of rats with an experimental stomach ulcer and during AP. [In Russian]. Fiziol Zh SSSR Jul;75(7):917-922. In white rats with experimental ulcer of the stomach, a single session of AP considerably increased the contents of beta-endorphine (ED) and adrenaline (A) in the hypothalamus. Repeated AP sessions aided to a progressive decrease in the ED, A and noradrenaline (NA) levels. AP did not change essentially the dynamics of ED, A and NA by itself. The ulcer pathology against the background of AP sessions is accompanied by a change in activity of hypothalamic systems of the ED, A and NA, and by a formation of a specific neurochemical profile changing in time.

Burtsev VI, Prineslikov AP (1997) The results of combined AP and laser therapy of outpatients with duodenal ulcer. [In Russian]. Klin Med (Mosk) 75(2):34-36. Exacerbations of duodenal ulcer (DU) were treated outpatient in 130 DU sufferers who failed previous chemotherapy. The treatment consisted of AP, laser therapy, diet and drugs. All the patients achieved remission, relief of vegetative disorders. DU healing took less time (by 7-10 d) than in control group. Application of the AP and laser radiation allowed assignment of minimal drug doses. 3-year long-term results showed the absence of recurrences for 1-3 years. 87 DU patients gave up smoking after additional AP according to the special regimen. AP combined with laser therapy was safe, usable and effective against DU in outpatient setting.

Chen Y, Cao Y, Xiao D, Ceu C, Chen M (1993) The relation between protective effect of moxibustion on gastric mucosa and mucus. [In Chinese]. Chen Tzu Yen Chiu 18(4):300-304.
Zhenjiang Med Coll, Jiangsu, PRC. Our previous works have proved that moxibustion at "ShenJue" plays a role in protecting gastric mucosa in the experimental gastric ulcer model rat. The present studies are designed to determine whether the mechanisms of moxibustion protecting gastric mucosa are mediated by mucus. Either before or after the experimental gastric ulcer model had formed, moxibustion could markedly increase the ratio of PAS positive staining layer to total length of gastric gland (p<.05), and the combined gastric mucus of stomach (p<.05). These results were negatively correlated to gastric ulcer area. THe data suggest that the mechanisms of moxibustion protection on gastric mucosa are mediated by mucus in the experimental gastric ulcer model rat.

Chen Y, Xiao D, Wang F, Cao Y, Ji J, Chen M (1992) Effects of moxibustion on experimental gastric ulcer in rats. [In Chinese]. Chen Tzu Yen Chiu 17(2):113-116.  Dept of Physiology, Nantong Med Coll, Jiangsu. This study was designed to determine whether moxibustion at "Shenjue" plays a role in protecting gastric mucosa in rats. The areas and histological changes of gastric ulcer were examined. Moxibustion pretreatment within 3 weeks significantly prevented the formation of gastric ulcer. As gastric ulcer had formed, moxibustion couldn't shorten the period of recovery of gastric ulcer. Moxibustion pretreatment at "Shenjue" had a protective effect on gastric mucosa. After the experimental ulcer had formed, however, the moxibustion had little protective effect on it.

Chen M, Cheng N, Chen Y, Zhong R, Ren C (1995) The effect of moxibustion on gastric mucosa in rats and its relation to copper, zinc contents in serum. [In Chinese]. Chen Tzu Yen Chiu 20(2):45-47. Dept. of Physiology, Zhenjiang Med Coll. 18 rats were randomly deivided into 3 groups: control grup, the group merely with experimental gastric ulcer and the group with experimental gastric ulcer after 3-week moxibustion. Moxibustion significantly reduced the ulcer area of the rats (p<.05). Compared with control group, the experimental gastric ulcer model rats had an increase in copper content and Cu/Zu ratio, the differences were statistically significant (p<.05, p<.01). In contrast to the rats merely with experimental gastric ulcer, moxibustion-pretreated rats gave a significant increase in serum Zn content (p<.01), but serum Cu and Cu/Zn ratio were significantly decreased (p<.05, p<.01). Moxibustion pretreatment at "ShenJue" protected the gastric mucosa from stress-induced ulcer. There was a disbalance in trace elements metabolism, but moxibustion could improve it. This may be one of the mechanisms of moxibustion protection on gastric mucosa.

Cheng X, Yang JB (1991) Effects of chrono-AP na ja fa on gastric acid secretion, plasma gastrin and prostaglandin E1 in patients with peptic ulcer. [In Chinese]. Chung Hsi I Chieh Ho Tsa Chih Feb;11(2):91-93. AP Dept of Chengdu Coll of TCM. Observations on gastric acid secretion, plasma gastrin and prostaglandin E1 in patients with peptic ulcer disease were made after giving AP with Na Ja Fa. The relationship between the chosen points and their effects was also discussed so as to provide more evidence to evaluate and practice the traditional chrono-AP more accurately. Gastric acid output of patients with peptic ulcer disease was decreased, while the plasma gastrin and prostaglandin E1 were increased after AP. This reveals that the decrease of acid output was not caused by the change of plasma gastrin, however the plasma prostaglandin E1 may be involved in this process. By using points on Stomach and Spleen meridians, there was a better inhibiting effect in acid output than treating the points of other meridians. This showed that using chrono-AP should include choosing points according to differentiation and only by laying stress on the relative specialization of the actions of these points one could expect improvement in efficiency. (3) There were no obvious differences between the standard opening points and the group of points which changed to opening points by Dr Shan Yu Tang. This proves that these two groups of points do have some similar functions and are both effective for clinical use.

Cheng X (1992) Effect of circadian rhythm on the action of AP to prevent the formation of experimental gastric ulcer. [In Chinese]. Chen Tzu Yen Chiu 17(2):117-122. Dept of AP, Beijing Hosp of TCM. Taking rats and mice as subjects, observation had been made on the protecting action of AP to prevent the gastric mucosa from experimental injury. The pH value (by accurate test paper), gastric acid output (by titration), the secretion of PG in gastric mucosa (by radioimmunoassay) were observed altogether at 1-3h, 5-7h, 9-11h, 13-15h, 17-19h and 21-23h. All of the above indices were changed along with the alternation of day and night. And the effects of AP on these indices were different when giving AP at different times. The action of AP to prevent experimental gastric ulcer was also different at different times. It is the general regularity that puncturing at the acrophase of circadian rhythm, the effect was mainly inhibitory, while puncturing at the valleyphase, the effect was mostly excitatory. Therefore, utilizing the influence of the various phases of circadian rhythm on the AP effect, to choose the optimum time giving AP could be one way to promote the AP curative effect.

Debreceni L, Denes L (1988) AP treatment for duodenal ulcer. Acupunct Electrother Res 13(2-3):105-108. Mohacs Hosp, Hungary. The effect of AP therapy for duodenal ulcer was investigated in 21 male and female patients. The diagnosis and healing were verified by gastroscopy. It was found that the needle therapy for 3 weeks led to complete recovery in 76% of the patients. Diet, alcohol and cigarette abstinency were necessary for healing. Cuti-visceral reflex activation eliciting the improvement of the secretory and motor function of the gastrointestinal tract and effects in the CNS leading to analgesia and tranquilization may play a role in the mechanism of action. AP can be satisfactory method to cure duodenal ulcer.

Degtiareva II, Kharchenko NV (1992) Nondrug methods in the combined treatment of peptic ulcer patients. [In Russian]. Lik Sprava Sep;9:76-80. Use of treatment complexes including non-drug methods (ear AP, pathogenetic dietotherapy, ILBR) or reduced doses of modern pharmacopreparations allowed to achieve rapid clinical and endoscopic remission in patients with ulcer disease. Simultaneously occurs normalization of the aggressive and defensive properties of the gastric juice, immunological, microcirculatory changes in the body and gastroduodenal mucosa. The vascular laser blood radiation reduced antacid dose and pathogenetic dietotherapy.

Dogotar' VB, Tkach SM, Bychkova NG, Trach EN (1992) The efficacy of different regimens for using millimeter-wave resonance therapy in duodenal peptic ulcer. [In Russian]. Lik Sprava Mar;3:85-87.

Durinian RA, Loginov AS, Osipova NN, Mel'nikova MN (1982) Various aspects of reflexotherapy in peptic ulcer. [In Russian]. Ter Arkh 54(2):41-46.

Durinian RA, Zol'nikov SM, Polianskaia ZM, Osipova NN, Mel'nikova MN (1982) Determination of the economic efficiency of using reflexotherapy in peptic ulcer in the hospital. [In Russian]. Sov Zdravookhr 9:14-18.

Emel'ianenko IV, Orzheshkovskii VV (1992) The theoretical bases and clinical efficacy of AP in peptic ulcer. [In Russian]. Lik Sprava Jan;1:69-72.

Emel'ianenko IV, Serediuk NN (1991) AP and pharmacological repair agents in the combined treatment of peptic ulcer patients. [In Russian]. Vrach Delo Jul;7:56-58.

Emel'ianenko IV (1991) The effect of AP on the psychosomatic status of peptic ulcer patients. [In Russian]. Vrach Delo May;5:98-100. A study of the psychosomatic effects of AP treatment of ulcerative diseases indicates that a course of AP gives psychological rehabilitation of these patients and significant improvement of the functional indices of the gastroduodenal system. It is supposed that AP influences the general mechanisms of ulcer disease pathogenesis, normalizes the cortico-hypothalamo-visceral relations.

Emel'ianenko IV, Bragin EO (1989) The DOPA and dopamine content in the hypothalamus and brain stem of rats with an experimental stomach ulcer against a background of a course of AP. [In Russian]. Biull Eksp Biol Med Mar;107(3):274-279. In experiments on rats with experimental ulcer of the stomach (EUS) using spectrofluorometric method the increase of DOPA and dopamine (DA) in brain stem, has been revealed as well as DOPA in hypothalamus. Change of the level of DOPA takes place at an early stage of ulcer formation. AP inserts essential corrections into the distribution of catecholamines under study. So, the content of DOPA and DA in hypothalamus and particularly in the brain stem in rats with EUS against the background of AP sharply increases. It has been supposed that AP realizes its therapeutic influence during ulcer disease due to the alteration of catecholaminergic brain system.

Fu Z (1995) A study on factors of AP methods affecting effects through AP treatments for experimental gastric ulcer in rats. [In Chinese]. Chen Tzu Yen Chiu 20(2):40-44. Dept of TCM, First Military Med Univ, Guangzhou. Many factors, such as the selection of AP points, the interval between sessions, the AP time, the manipulation and the specification of AP needles, are capable of affecting curative effects. There were some studies on these factors ago. However each of these studies only related to a single factor. These studies could not reflect the clinical truth, and could not provide accurate overall data for medical staff. In order to solve the above problems, we carried out an animal experiment designed by L9 (3(4)) orthogonal design. The experiment which consisted of 9 AP groups and 3 control ones was carried out in 108 rats, which were suffered from experimental gastric ulcer. In the experiment, the body weight, ulcer area, plasma SOD and LPO of each rat were observed. In the AP treatments for experimental gastric ulcer in rats, EAP treatment for 10 minutes via thinner needles and treatment every other day were the best methods. Explanations for the above results were elucidated.

Gorbashko AI, Samofalov AA, Rakhmanov RK, Mikhailov AP, Shu'lgin VL (1989) Use of helium-neon lasers in the treatment of peptic ulcer. [In Russian]. Vestn Khir Jul;143(7):31-34. An analysis of treatment of ulcer disease of the stomach and duodenum with the help of helium-neon lasers has been made. The pathological focus (ulcer) was influenced in two ways: through the endoscope and by means of biologically active points. Positive effects were obtained in 96.9% of the patients. Operations were performed on 3.1% of the patients where laser therapy failed to give good effects. Contraindications to laser therapy were considered to be bleeding, callous and malignant ulcers.

Ivanov VI, Gavriuchenkov VP, Kovyleva NA (1983) AP in the combined treatment of peptic ulcer. [In Russian]. Voen Med Zh Jun;6:57-58.

Kokurin GV (1992) Autonomic disorders in the clinical picture of gastric and duodenal peptic ulcer and their AP reflexotherapy. [In Russian]. Zh Nevropatol Psikhiatr Im S S Korsakova 92(5-12):9-10. Patients with peptic ulcer show diverse psychovegetative disorders that complicate the course of the somatic disease. Depending on the intensity of psychovegetative disorders the following syndromes were distinguished: astheno-neurotic, astheno-hypochondriac, astheno-depressive and psycho-vegetative with organic microsymptomatology. The use of laser puncture in multimodality therapy of peptic ulcer patients favours correction of vegetative disorders and normalization of regenerative processes occurring in the gastroduodenal system.

Koval' ON, Pavlichenko SA, Sarian IV, Kurbanov UM (1990) The efficacy of the laser therapy of peptic ulcer patients. [In Russian]. Vrach Delo Jul;7:6-8. Data are reported of treatment efficacy of 67 patients with gastric and duodenal ulcer. In 52 combined treatment included lasers. Use of laser radiation produced a significant analgetic effect and stimulated epithelialization of the ulcer defect.

Kravtsova TIu, Rybolovlev EV, Kochurov AP (1994) The use of magnetic puncture in patients with duodenal peptic ulcer. [In Russian]. Vopr Kurortol Fizioter Lech Fiz Kult 1994 Jan;1:22-24. 66 patients with duodenal ulcer were found to have apparent shifts in psychovegetative correlations. The patients underwent puncture with alternating magnetic field of active biological points responsible for general adaptation (ST36, GV14, GB20) and gastroduodenal function (ST20, CV09, CV08). The treatment improved emotional, personality and vegetative regulation. The symptoms declined and ulcer healed more rapidly.

Kravtsova TIu, Rybolovtsev EV, Shutov AA (1993) A psychoautonomic syndrome in duodenal peptic ulcer patients and its correction by magnetic puncture using an alternating magnetic field. [In Russian]. Zh Nevropatol Psikhiatr Im S S Korsakova 93(6):50-52. 86 duodenal ulcer patients were diagnosed to have serious psychovegetative disorders. Among other treatments, the patients were exposed to AMF puncture of biologically active points. The puncture produced optimization of the function of cerebral (suprasegmental) vegetative structures, promoted a regress of vegetative dystonia clinical symptoms and speeded up ulcer healing.

Kutsenok VA, Nikula TD, Stechenko LA, Andreenko TV, Kuftyreva TP (1995) The ultrastructural characteristics of the duodenal mucosa in peptic ulcer patients undergoing treatment with EHF-range electromagnetic radiation. [In Russian]. Lik Sprava May;5-6:93-97. An effect was studied of electromagnetic radiation of the millimetric wave band (EHF EMR) on ultrastructural processes of the mucosa and healing of ulcer in 10 patients with duodenal ulcer. Biopsy specimens were taken from the base of the margin of the ulcer and in the area 1 cm from the margin of the ulcer defect before the treatment, after 5 and 10 sessions of EHF EMR to AP points. EHF EMR had a stimulating effect on the processes of ulcer regeneration. Seen after session 5 are layers of proliferating poorly differentiated enterocytes, activation of immune and autoimmune processes, normalization of the hemomicrovessel endothelial cell structure, filling in the ulcer defect with a newly formed granulation tissue in which, among fibroblasts, macrophages, mast cells and lymphocytes, there prevail plasmic cells with an augmented secretion of immunoglobulins, increase in proliferation of epitheliocytes, with their differentiation slowing down, and a complete epithelialization of the ulcer following ten treatment procedures.

Kutsenok VA (1994) The effect of electromagnetic radiation in the millimeter-wave range on the immune status of peptic ulcer patients. [In Russian]. Lik Sprava Sep;9-12:139-142. Effects of MMW electromagnetic radiation on the immunity status were studied in 92 patients with ulcer of duodenum before and after the course of treatment which consisted of 8-10 sessions of exposure, using AP points for the purpose, for 20-25 minutes daily, the immunocorrective action of the method used having been made evident. Both quantitative and qualitative indices for the immunity system return to normal, with the ratio of lymphocyte regulatory subpopulation being restored, functional activity previously suppressed, of immunocompetent cells being enhanced, the level of autoimmune processes lowered.

Liu L, Zhou L, Zhang D, Li J (1994) Effects of AP on antral G cells in patients with gastric disease. [In Chinese]. Chen Tzu Yen Chiu 19(2):75-78. Dept of Physiology, Chinese Academy of Med Sciences, Beijing. It is well known that AP is effective for treatment of gastric disease in human. We observed the effect of AP at CV12, PC06, ST36 on fluorohistochemical changes of G cells of antral mucosa in 42 patients with gastric disease. As compared with pretreatment values, AP clearly decreased the amount of fluorescent G cells and the fluorescent intensity of gastrin in the G cells in patients with duodenal ulcer. However, AP increased the amount of G cells in patients with chronic atrophic gastritis. AP in gastric disease may normalise G cells in gastric mucosa.

Luo LC (1980) Dynamic observations during the course of treatment of acute perforation of peptic ulcer by integrating TCM and Western medicine. [In Chinese]. Chung Hua Wai Ko Tsa Chih Feb;18(1):20-22.

Mal'kuta MA, Kudin VP (1995) The efficacy of physiotherapeutic methods in the combined treatment of duodenal peptic ulcer. [In Russian]. Voen Med Zh Jun;6:42-43.

Markelova VF, Belitskaia RA, Mel'nikova MN, Shumova OV (1984) Reflexotherapy in duodenal ulcer. [In Russian]. Sov Med 9:13-17.

Markelova VF, Osipova NN, Belitskaia RA, Mel'nikova MN (1983) State of the sympathico-adrenal system during reflexotherapy of duodenal ulcer. [In Russian]. Ter Arkh 55(9):115-117.

Markelova VF, Malygina SI (1985) State of the sympathico-adrenal system during reflexotherapy of duodenal ulcer: Effect of reflexotherapy on the function of the hypophyseal-adrenal system. [In Russian]. Patol Fiziol Eksp Ter Jan;1:38-41.

Mattig W, Buchholz W, Schulz HJ (1979) Severe iatrogenic lesions caused by Huneke's neural therapy. [In German]. Z Gesamte Inn Med Mar 1;34(5):143-147. During a combined AP-neural therapy-treatment on account of a gastric ulcer several lesions with vast haemorrhages in the abdominal cavity and in the retroperitoneal space on the right (lesions of the kidney) were produced. At the operation a duodenal ulcer without perforation was found. The competence of the neural therapy in its relation to the complications is discussed, the indication to the application of these forms of therapy in such cases is refused.

Mishchenko VA (1990) Psycho-reflexotherapy in the combined treatment of chronic diseases of the stomach and duodenum in children. [In Russian]. Pediatriia 11:109-110.

Nikula TD, Kan EB (1991) The effect of hypnotic suggestion and millimeter-range electromagnetic radiation on the clinical and endoscopic indices in peptic ulcer patients. [In Russian]. Vrach Delo May;5:59-61. The authors studied the effect of microwave resonance therapy, hypnosuggestion and their combinations on the dynamics of clinico-endoscopic indices in 182 patients with duodenal ulcer. It was established that these methods were highly effective allowing to control rapidly the pain syndrome, to achieve complete healing of the ulcer in 70-95% of cases within 14.8-16.7 d. Combination of both methods gave the best results.

Osipova NN, Mel'nikova MN, Zabludovskaia EN, Prokhorova TN (1982) Reflexotherapy in the combined treatment of stomach and duodenal ulcers. [In Russian]. Sov Med 9:98-100.

Pan C, Jin W, Shen D (1990) An observation of protective effect of AP on the gastric mucosa of Wistar rats and the relative histochemical changes of the neurotransmitters. [In Chinese]. Chen Tzu Yen Chiu 15(1):48-54. Inst of AP and Meridians, Anhui Coll of TCM, Hefei. In this paper, changes of neurotransmitters and the protective effect of AP on gastric mucosa have been studied by the histochemical methods of cholinesterase and catecholamine on 30 pairs of Wistar rats. 1. Sequential medical trials on rats of water-immersion induced gastric ulceration show that there was a protective effect of EAP on gastric mucosa and it was statistically significant. 2. Under the protective effect of AP on gastric mucosa, finally, both the cholinergic and adrenergic nerves undergo significant inhibition.

Petrov AV, Bychkova NG, Perederii VG, Dogotar' VB, Vysotiuk LA (1993) Drug and non-drug immunocorrection in peptic ulcer. [In Russian]. Lik Sprava Apr;4:100-102. Drug immunocorrection and microwave resonance therapy allowed to normalize the immune status in 93% of patients with ulcer disease. This allowed to achieve clinico-endoscopic remission in 82%, reduce scarring time on the average by 6-7 d and to reduce markedly the recurrence frequency.

Qian LW, Lin YP (1993) Effect of EAP at zusanli (ST36) point in regulating the pylorus peristaltic function. [In Chinese]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Jun;13(6):336-339. First Affiliated Hosp, Hunan Coll of TCM, Changsha. The effect of EAP at ST36 in regulating the human pylorus sphincter pressure was investigated in this study by means of the endoscopic manometry. After EAP at ST36, the amplitude of the low wave of pylorus sphincter pressure was raised and the amplitude of the high wave was reduced significantly while the amplitude of the middle wave did not reveal significant change, compared with the data from the control-group and the non-AP point group. ST36 may have dual effect on the regulation of the pylorus peristaltic function, which expressed itself as enhancing the hypofunction and weakening the hyperfunction of pylorus peristalsis.

Qiao X, Yin K (1992) Therapeutic effect of moxibustion on experimental gastric ulcer of rats and its mechanism. [In Chinese]. Chen Tzu Yen Chiu 17(4):270-273.

Salvi E, Pistilli A, Romiti P, Bedogni G, Pedrazzoli C (1983) Duodenal ulcer: Gastroscopic aspects before and after AP treatment. [In Italian]. Minerva Med Nov 3;74(42):2541-2546. 4 cases of duodenal ulcer, diagnosed by gastroscopy, three of which were already treated medically with insufficient results, are presented. AP was carried 5-7 times during 1-2 months and induced a complete disappearance of the clinical symptoms and complete healing of the former lesion was diagnosed through gastroscopy

Shaginian KS (1988) Effect of phonopuncture on gastric motor function in patients with duodenal ulcer . [In Russian]. Vopr Kurortol Fizioter Lech Fiz Kult Jan;1:30-32.

Shen D, Liu B, Wi D, Zhang F, Chen Y (1994) Effects of EAP on central and peripheral monoamine neurotransmitter in the course of protecting rat stress peptic ulcer. [In Chinese]. Chen Tzu Yen Chiu 19(1):51-54. Inst of AP and Channel, Anhui Coll of TCM, Hefei. The experimental Wistar rats were divided into two groups, the AP group and the control group. Stress-induced gastric ulcer models were established by immersion of restrained rats in water. EAP protected against stress-induced peptic ulceration. EAP inhibited synthesis and decomposition of central and peripheral 5-HT. Compared with the control group, the EAP group had higher NE levels in the three brain regions (cortex, hypothalamus, brainstem) and blood, and higher levels of DA in blood and gastric tissue, and lower NE levels in gastric tissue. The protective efect of EAP in rat stress ulceration was related to monoamine neurotransmitters in the CNS and periphery.

Shen D, Wei D, Liu B, Zhang F (1995) Effects of EAP on gastrin, mast cell and gastric mucosal barrier in the course of protecting rat stress peptic ulcer. [In Chinese]. Chen Tzu Yen Chiu 20(3):46-49. Inst of AP and Channel, Anhui Coll TCM, Hefei. The experimental Wistar rats were divided into two groups, the AP group and the control group. Stress-induced gastric ulcer models were established by immersion of restrained rats in water. EAP protected rats from stress-induced peptic ulcer. The protective effect of EAP from stress ulceration in rats was related to enhancing gastric mucosal barrier, stabilizing gastric mast cell and inhibiting the gastrin levels in gastric mucus.

Shi AS (1985) Advances in clinical observations and experimental research on peptic ulcer treated with TCM and western medicine. [In Chinese]. Chung Hsi I Chieh Ho Tsa Chih Jan;5(1):59-62.

Sodipo JO, Falaiye JM (1979) AP and gastric acid studies. Am J Chin Med 7(4):356-361. The effects of therapeutic AP on gastric acid secretion on pain relief in chronic duodenal ulcer patients were studied. Ten adult Nigerian patients with clinical, endoscopic as well as radiological evidence of duodenal ulcer constituted the "Ulcer Group." 4 other patients who gave history of dyspepsia formed the "Dyspeptic Group." Pentagastrin stimulation test was performed on all subjects pre- and post-AP therapy. Classical AP points were used. The mean Basal Acid Output (BAO) in the duodenal ulcer group was markedly reduced from 4.04+1.01 mMols/h to 1.05+2.5 mMols/h. The mean Maximal Acid Output (MAO) was lowered from 34.72+13.81 mMols/h to 15.34+4.01 mMols/h. The difference was statistically significant (p<.001). It is more probable, therefore, that the relief of pain is attributable to the therapeutic inhibition of gastric hyperacidity in our patients. AP has been shown previously to induce pain relief but the results of this investigation also showed that AP achieves symptomatic relief through therapeutic gastric depression in duodenal ulcer patients.

Starodub IeM, Samohal's'ka OIe, Markiv IM, Luchanko PI (1994) The effect of superhigh-frequency electromagnetic radiation on the course of Helicobacter pylori-associated peptic ulcer. [In Ukrainian]. Lik Sprava Jan;1:85-87. The authors studied effects of microwave electromagnetic irradiation on the course of peptic ulcers and dissemination with Helicobacter pylori in 60 patients with various severity of the disease. Microwave irradiation not only hastens clinico-endoscopical remission of the disease but also considerably reduces dissemination of mucosa with Helicobacter pylori.

Steiner RP (1983) AP: cultural perspectives: 1: The Western view. Postgrad Med Oct;74(4):60-67. While AP has been popularized in the lay press for the past decade, its therapeutic efficacy has often been clouded by issues of Oriental mystique and difficulties in understanding a foreign medical system. Numerous studies have explored the mechanism by which AP works. The effects of AP constitute a generalized systemic reaction with far-reaching consequences. AP has numerous clinical applications in obstetrics and dentistry, as well as use in the treatment of asthma, musculoskeletal disorders, various addictions, angina pectoris, peptic ulcer disease, functional bowel disorders, and acute bacillary dysentery.

Teppone MV, Vetkin AN, Kalin AA, Krotenko AA (1991) Ultrahigh frequency therapy of duodenal ulcer. [In Russian]. Klin Med (Mosk) Oct;69(10):74-77.  Extremely high frequency (EHF) radiation was performed in 95 outpatients with duodenal ulcer. Individual choice of the exposure site can improve the treatment results. The syndrome-oriented approach of the Chinese conventional medicine warrants an effective choice of the AP points and the prognosis of the outcome. A clinical syndrome was identified in which healing of the ulcer was achieved on week 2 of the treatment in 92.3+7.7% of the patients. EHF therapy provides positive responses in case of a valid exposure zone selection, the frequency being less important.

Vinogradov VG, Kisel' LK, Mager NV (1994) The results of treating gastric and duodenal peptic ulcer by using the millimeter-range wavelength. [In Russian]. Lik Sprava Jan;1:83-85. Combined treatment of peptic ulcer with drugs and millimeter electromagnetic waves (MEW) allows to shorten stay in hospital by 2 weeks. Ambulatory MEW therapy may be effective even if used without any drugs, especially in young patients with fresh ulcer. Thus, MEW treatment is recommended by the authors to be widely applied for the treatment of peptic ulcer both in hospital and out-patient Depts.

Weissmann R (1978) Therapeutic AP in gastroenterology. [In German]. Fortschr Med May 4;96(17):901-902. AP today has more and more become accepted as an effective therapeutic method and has long overcome the savour of hypnosis and suggestion. For patients suffering from chronic pain due to a variety of conditions, particularly functional diseases, this method often proves to be the only help. We recommend to use AP following extensive diagnostic measures. There is no risk for the patient; a good deal of benefit, however, can be expected.

Xu PC (1989) Treatment of acute gastric pain by needling AP points ST34 and BL21. JTCM Jun;9(2):84-86.

Xu GS, Chen RX, Shen DK (1987) Protection by AP on gastric mucosal damage in rats. [In Chinese]. Chen Tzu Yen Chiu 12(3):214-218.

Yuan CX, Li RM, Zhu J, Jin NS, Zhang DZ, Yan CY (1986) The curative effect and mechanism of action of the AP points BL20 and BL21. JTCM Dec;6(4):249-252.

Zakharov PI, Builin VA, Eliseenko VI, Peskov VP (1991) Phototherapy of peptic ulcer patients using a semiconductor laser. [In Russian]. Vrach Delo Mar;3:77-79. 470 patients with peptic ulcer were given external semiconductor laser therapy. The average time of ulcer healing was twice shorter than in control cases. Ulcer epithelialization depended on the severity of the disease, diameter and depth of the ulcer defect. Prophylactic treatment is recommended to reduce the number of recurrences.

Zheng XL, Chen C, Wu XZ (1985) AP therapy in acute abdomen. Am J Chin Med 13(1-4):127-131. AP as a therapeutic measure for abdominal pain was early recorded in Huangdi Neijing ("Yellow Emperor's Canon of Medicine"). Fruitful experiences have been accumulated in the practice of the long historical years. Nowadays AP therapy has become one of the main therapeutic methods in surgical acute abdomen and is widely used clinically.

Zhou Q (1987) Progress in the study of gastric duodenal ulcer perforation treated with TCM combined with Western medicine. [In Chinese]. Chung Hsi I Chieh Ho Tsa Chih Aug;7(8):506-508.

B. ULCERATIVE COLITIS
(Note that if colitis alone were used, many more hits would have resulted)

Chen Z (1995) Treatment of ulcerative colitis with AP. JTCM Sep;15(3):231-233. Inst of AP, China Academy of TCM, Beijing.

Fischer MV (1982) AP therapy in the outpatient-Dept of the Univ Clinic Heidelberg. [In German]. Anaesthesist Jan;31(1):25-32. Encouraged by the good results obtained using AP anaesthesia, we started therapeutic AP in our institute of anaesthesiology 4 years ago. In the meantime AP is as important a therapeutic method in our out-patients Dept as are therapeutic local anaesthesia, transcutaneous electrical nerve stimulation and biofeedback. The results in 520 patients who were treated with AP for different diseases are reported. The success of treatment, the number of sessions and the recurrence-rate within one and a half years are discussed for the different diseases. AP treatment was regarded successful when 1, the patient had no complaints at all without medication, and 2, when there was significant improvement (no long term medication, only mild complaints with unusual strain, which were responsive to minimal medication). Thus treatment in cephalgia was successful in 83% with no recurrences (NR) in 84%. In cervical pain syndromes, success rates were 80% (NR=74%) in constipation 80% (NR=72%), sinusitis 86% (NR=100%), insomnia 100% (NR=100%). Good results, albeit with high recurrence rate were achieved in cases of trigeminal neuralgia in 90% (NR=23%), colitis ulcerosa in 100% (NR=0%), in bronchial asthma 70% (NR=50%) and in tumour pain 61% (NR=0%). Treatment in patients suffering from parathymic conditions were unsatisfactory and results in cases of tinnitus were negative.

Fischer MV, Behr A, von Reumont J (1984) AP: a therapeutic concept in the treatment of painful conditions and functional disorders: Report on 971 cases. Acupunct Electrother Res 9(1):11-29. The results in 971 outpatients treated with AP for different diseases are reported. The outcome of treatments and number of sessions are discussed in relation to the different diseases. AP treatment was regarded as successful when 1. the patients had no pain at all without medication and 2. there was a significant improvement (no long-term medication, only mild pain under unusual strain, minimal medication under such circumstances). We obtained positive results in cephalalgias , sinusitis, cervical spine syndrome, shoulder-arm syndrome, ischialgias , back pain, constipation, herpes zoster, allergic rhinitis and disturbances of peripheral blood flow. For the following ailments, in order to reduce the medication, we recommend AP despite a high rate of recurrence: Trigeminal neuralgia, colitis ulcerosa, bronchial asthma and cancer pain. Results in the treatment of mental disturbances were unsatisfactory, and in cases of tinnitus results were negative.

c. OTHER FORMS OF ULCERATION, PERIPHERAL ISCHAEMIA
(Note that if gangrene, decubitus, ischemia and other keywords were added, more hits would have resulted)

Bacchini M, Conci F, Roccia L, Carrossino R (1979) Circulatory disorders and AP. [In Italian]. Minerva Med May 19;70(24):1755-1757. The present study was designed to examine whether AP is useful in the treatment of some disorders of the vascular system as the thromboangiitis obliterans of the extremities, the Raynaud's disease and in the therapy of ulcers by venous stasis. From the data presented it appears that AP is effective in releasing the arterial spasm and especially in increasing the circulation in collateral vessels. In order to prove the efficiency of AP in the above disorders, the response to AP was compared with that obtained by a pharmacological treatment with lumbar paravertebral block.

Bernardo ND, Cappuccio S, Ferlazzo F (1978) Treatment of postphlebitic ulcers of the lower limb by EAP. [In Italian]. Minerva Med Sep 22;69(44):2979-2987.

Bogdanovich UIa, Karimov MG (1984) Use of optical quantum generators (lasers) to treat orthopedo-traumatologic patients. [In Russian]. Ortop Travmatol Protez Oct;10:60-65.

Celoria R, Bacchini M, Roccia L (1976) Reflexotherapy (AP) in the treatment of ulcer caused by venous stasis of the lower extremities. [In Italian]. Minerva Med Jan 31;67(5):350-355.

Chong Y, Lee HJ, Lee SY, Jahng JS, Yang KH (1982) Pasteurella multocida infection of the calf in a patient who had moxa cautery treatment for degenerative arthritis. Yonsei Med J 23(1):65-70

Di Bernardo N, Martines F, Ferlazzo F, Barresi G, Gemelli F, Biondo G (1980) Morphohistochemical aspects of post-phlebitic ulcers of the lower extremities in treatment with EAP. [In Italian]. Minerva Med Mar 31;71(12):877-897.

Di Bernardo N, Ferlazzo F, Biondo G, Cucinotta E, De Meo A (1980) EAP and trophic ulcer. [In Italian]. Minerva Med Dec 22;71(51):3715-3718. EAP was used in the treatment of 50 cases of tropic ulcer of the lower extremities, including 34 following phlebitis, by stimulation with a Roccia VTM apparatus at voltages and frequencies up to the patient's tolerance threshold. The needles stimulation was maintained for a maximum of 7 hr. A cure was obtained in all cases, including those where the ulcers were inveterate and resistant to routine forms of management.

Di Bernardo N, Crisafulli A, Gemelli F, Ferlazzo F, Cucinotta E, Foti A (1980) Experimental research on the effect of EAP on reparative processes. [In Italian]. Minerva Med Dec 22;71(51):3709-3713. With a view to clarifying the mechanism whereby EAP aids the repair of trophic ulcers, including inveterate forms resistant to ordinary treatments, reference is made to histochemical findings and histological findings in periulcerous tissues and experimental research into wound healing. Preliminary work showed that EAP improves the blood supply to ulcerous tissue and the local biochemistry, and accelerates the repair process. Experimental work also made it clear that the method, when use on alternate days with the modalities used in clinical practice, accelerates the healing of wounds in experimental animals.

Efimov AS, Sit'ko SP (1993) The theory of the sanatogenesis (the mechanism of the therapeutic effect) of microwave resonance therapy. [In Russian]. Lik Sprava Sep;9:111-115. On the basis personal experience in millimeter resonance therapy in the treatment of several diseases (diabetes mellitus, ulcers, etc.. data are reported on substantiating the theory of sanogenesis of this method. Various biochemical, immunological, hormonal studies in the experiment and clinic indicate that the basis of the treatment effect of electromagnetic radiation is restoration of homeostasis by activation of compensatory systems. The levels and systems influenced by electromagnetic radiation are indicated. The stage-like character of these influences is stressed.

Ewins DL, Bakker K, Young MJ, Boulton AJ (1993) Alternative medicine: potential dangers for the diabetic foot. Diabet Med Dec;10(10):980-982. Manchester Diabetes Centre, UK. Two patients with non-insulin-dependent diabetes mellitus and previously undiagnosed peripheral neuropathy consulted separate practitioners in alternative medicine with symptoms of painful cold feet. They both received moxibustion, a TCM therapy, and subsequently developed painless ulceration at the sites of treatment on the feet and legs. These cases re-emphasize the dangers of trauma to the neuropathic limb in patients with diabetes.

Hiemer H, Muller SK (1977) AP as after care following injuries of the upper extremities. [In German]. Handchirurgie 9(3):129-134. AP can improve restriction of motion in general and in the smaller joints of the upper extremity, disturbances in circulation, posttraumatic swelling, reversible nerve lesions and ulcers following burns or pressure of a plaster. Localisation of the points for AP in the different conditions and the possibilities of their combinations are described. AP is performed bilaterally at symmetrical points, unilaterally in pareses, contralaterally in amputees and in cases with dressings. During ear AP the analgesic effect occurs more quickly, but has a shorter duration of action; in paralyses it was without success. The course of the treatment was controlled by clinical examination and measurement of the range of motion.

Hong SY, Wang XL (1991) Clinical effects and immune regulation of musk-moxa-string therapy in 39 patients with scrofula. [In Chinese]. Chung Hsi I Chieh Ho Tsa Chih Aug;11(8):465-467. Dept of TCM, Union Hosp, Tongji Med Univ, Wuhan. Immunological function and lymphocytic subsets of peripheral blood mononuclear cell (PBWC) from 39 patients with scrofula were investigated before and after treatment with musk-moxa-string therapy. The % of CD3+, CD4+ cells and the ratio of CD4+/CD8+ cells were markedly decreased in the patients than normal control (p<.001). On the contrary, the numbers of B lymphocytes and DR+ cells were increased. But the response of PBWC to phytohemagglutin in (PHA) stimulation markedly decreased in the patients than the normal control. After treatment with musk-moxa-string therapy, the % of CD3+, CD4+ cells and the ratio of CD4/CD8 were increased (p<.001) and blastogenic response to mitogen stimulation with PHA recovered to normal. Meanwhile, the symptoms was improved and swell lymph node disappeared or was reduced markedly in size and the ulcer was healed completely. The effect of musk-moxa-string therapy is caused by the enhancement of immunological capacity of the patients.

Jagirdar PC (1986) The usefulness of AP in leprosy. Indian J Lepr 1986 Oct;58(4):618-622. The damage to motor nerves in leprosy causes imbalance at various joints and these postural alterations result in various deformities. Active exercises which can prevent disuse atrophy of muscles, are not possible when the muscles are completely paralyzed. Needleless EAP produces electric impulses similar to nerve impulses. EAP done at the correct AP points can give active exercises to the paralyzed muscles and thus prevent disuse atrophy of the paralyzed muscles. EAP can serve as the most effective physical therapy to prevent and treat early deformities such as claw hand, foot drop, trophic ulcer, etc. AP can give relief from the neuritic pain in leprosy.

Kopecny L (1982) Treatment of vascular diseases of the lower extremities using electropuncture. [In Czech]. Fysiatr Revmatol Vestn Jun;60(3):133-137.

Kovalenko MF, Dergachev BP (1989) Rehabilitation of patients with ulcers under hospital conditions. [In Russian]. Voen Med Zh Jun;6:29-30

Lundeberg T (1993) Peripheral effects of sensory nerve stimulation (AP) in inflammation and ischemia. Scand J Rehabil Med Suppl 29:61-86. Dept of Physiology II, Karolinska Instt, Stockholm, Sweden.

Nielsen M (1986) AP and pain in dermatology. Dermatologica 173(3):143-145.

Proenca R (1966) Scarifications of the skin in ischemic pain in the legs. [In Spanish]. Angiologia Sep;18(5):228-231.

Ranuzzi De Bianchi V, Pagliarini A, Carinci P (1980) Evolution of experimental ulcers under treatment with EAP. [In Italian]. Minerva Med Dec 22;71(51):3719-3722.

Richand P, Boulnois JL (1983) Laser radiations in medical therapy. [In Italian]. Minerva Med Jun 30;74(27):1675-1682. The therapeutic effects of various types of laser beams and the various techniques used are studied. Clinical and experimental research has shown that Helio-Neon laser beams are most effective as biological stimulants and in reducing inflammation. For this reasons they are best used in dermatological surgery cases (varicose ulcers, decubital and surgical wounds, keloid scars, etc.). Infrared diode laser beams have been shown to be highly effective painkillers especially in painful pathologies like postherpetic neuritis. The various applications of laser therapy in AP, the treatment of reflex dermatologia and optic fibre endocavital therapy are presented. The neurophysiological bases of this therapy are also briefly described.

Rogers PA, Schoen AM, Limehouse J (1992) AP for immune-mediated disorders: Literature review and clinical applications. Probl Vet Med Mar;4(1):162-193. AP activates the defense systems. It influences specific and nonspecific cellular and humoral immunities; activates cell proliferation, including blood, reticuloendothelial, and traumatized cells; and activates leucocytosis, microbicidal activity, antibodies, globulin, complement, and interferon. It modulates hypothalamic-pituitary control of the autonomic and neuroendocrine systems, especially microcirculation, response of smooth and striated muscle, and local and general thermoregulation. Immunostimulant points include LI04, LI11, ST36, GB39, SP06, GV14, BL11, BL20, BL23, BL24, BL25, BL26, BL27, BL28, and CV12. Some, such as BL47, are immunosuppressive. Antifebrile points include GV14 and ST36. Reactive reflex SHU points, MU points, and earpoints are useful in organic diseases. In immunomediated diseases, some or all of these points can be used with other points, especially local points and points of the major symptoms or points of the affected body part, area, function, or organ. Applications of AP include treatment of inflammation and trauma; stimulation of tissue healing in burns, ulcers, indolent wounds, ischemia, necrosis, and gangrene; infections; postinfection sequelae; fever; autoimmune disease; allergies; anaphylaxis and shock; and treatment or prevention of side effects from cytotoxic chemotherapy and ionizing radiation. AP therapy may inhibit neoplastic cells. Examples of AP use in immunomediated conditions in small animals are given.

Timen AE, Kiselev AN, V'iunitskii VP, Zalesskii VN, Lysenkov NV (1989) Treatment of trophic ulcers with local laser irradiation and laser puncture. [In Russian]. Klin Khir 7:76-77.

Valery LP (1969) Homeopathy and AP: Lip ulcerations and mouth diseases. [In French]. Chir Dent Fr May 28;39(22):41-43.

Yuan SY (1989) Superficial blood flow (SBF) in 193 patients with traumatic paraplegia. [In Chinese]. Chung Hua I Hsueh Tsa Chih Sep;69(9):482-485. SBF in 15 regions (sacral spot and bilateral nail-fold, ST36, SP06, KI03, LV02, BL26 and femur) was measured by means of Laser Doppler Flowmeter in 193 patients with paraplegia resulted from trauma during the Tangshan earthquake, and the result was compared with that in 53 normal subjects. SBF in the patients' limbs was more decreased than that in normal subjects (p<.001). There was also a decline of SBF in the right femur as compared with the normal (p<.001). Bilateral nail-fold blood flow in 55 patients with injury of vertebrae thoracales was significantly lower than that in 38 patients with lumbar vertebrae injury, indicating that having lived for 12 years since spinal cord injury, the patients still have microcirculatory disturbance over the whole body. Since SBF at the predilection site of decubital ulcer was decreased significantly more than that at non-ulcer site, it would be very important to improve local microcirculatory perfusion for prevention and treatment of decubital ulcer.